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Methods: After approval by the Ethics Committee and obtaining informed consent of the patients, 150 pregnants, without any systemic illness or pathology of the foetus, undergoing CS under spinal anesthesia, assigned randomly to one of the six treatment groups (25 in each). After (Following) routine monitoring, patients were treated with one of the prehydration regimen: Group RL: IV 1000 mL Ringer's lactate (RL); group G: 500 mL gelatine (G) solution (Gelofusin, Braun), group RL15: 1000 mL RL+15 mg ephedrine (E); group G15: 500 mL G+15 mg E; group RL30: 1000 mL RL+30 mg E; group G30: 500 mL G+30 mg E. Spinal anesthesia was performed by 0.5% heavy bupivacaine aiming to achieve a sensorial block at T4 level. Blood pressure, heart rate, SpO2, anesthesia level, side effects were recorded every 3 min for the first 25 min and thereafter every 5 min until the end of the surgery. Mean arterial pressure lower than 20% of baseline values were treated with additional RL infusions. Hypotensive periods (hypt) longer than 3 min were treated with IV 5 mg E.
Results: No significant differences were detected in demographic data, anesthesia level and neonatal outcome between the groups. The highest incidence of tachycardia (heart rate higher than 20% of baseline) was observed in groups RL30 and G30.
Conclusion: Combinations of 15 mg or 30 mg E with 500 mL of G solution or 30 mg E with 1000 mL of RL reduced additional volume and vasopressor needs as well as other side effects of spinal anestheisa. However, tachycardia associated with higher doses of E may limit its prophylactic use. We conclude that the combination of 500 ml G with 15 mg E may be the preferrable prehydration fluid regimen before spinal anesthesia for CS.
